"When fascism comes to America, it will be wrapped in the flag and carrying the cross."
-- Sinclair Lewis

Tuesday, May 02, 2017

Ryan's "Healthcare" Monster Is Still Refusing To Die

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Monday morning, MarketWatch published a list of non-partisan health organizations opposed to the Frankenstein's monster of a bill known as TrumpCare (or the AHCA). We're talking about groups like the American Cancer Society, the American Diabetes Association, the American Heart Association, the American Lung Association, the Cystic Fibrosis Foundation, the March of Dimes... You get the picture. This is even beyond the already stated opposition from AARP and the American Medical Association. Exception in the deepest red and most backward ignorant districts, this is very meaningful. Look at this; it isn't something mainstream Republicans in Congress want to have to confront:

There are about 50 members of the mainstream Republican congressional caucus known as the Tuesday Group, although they keep their membership list secret. Charlie Dent (R-PA) is considered the leader and other members who have identified as members recently include Elise Stefanik (R-NY), Dan Donovan (R-NY), Ileana Ros-Lehtinen (R-FL), Adam Kinzinger (R-IL). Tom MacArthur (R-NJ), John Katko (R-NY), Mark Amodei (R-NV), Fred Upton (R-MI), Frank LoBiondo (R-NJ), Leonard Lance (R-NJ), Chris Collins (R-NY), Rodney Davis (R-IL)... Pragmatic and often in swingy districts, they're supposedly the opposite of the Freedom Caucus, who are ideological extremists. Most are hardly moderates but unless you define a "moderate" as anything to the left of Benito Mussolini, Mark Meadows or Louie Gohmert.Right now they're being pummeled by the far right for blocking the unpopular TrumpCare 3.0 bill that would kick 24 million people off healthcare and raise premiums for people with preexisting conditions by many thousands of dollars annually. Trump-- who has zero interest in policy and just wants something he can call "a win"-- decided to appease the Freedom Caucus extremists by making the bill even more untenable for mainstream Republicans. Now they're being threatened with primaries if they don't get on board.Tom Cole (R-OK), a former chairman of the NRCC, has urged other Republicans to appreciate the problem for the members from swing districts. "Some of our colleagues forget the Tuesday Group is the group that holds the toughest seats for us. They really are the difference between us being in the majority and the minority. So what they have to say is extremely important for everybody to listen to, because that’s where our losses will tend to come in a midterm."Many of the Tuesday Group Republicans are in better shapes for general elections therefor Republican primaries, which are more dominated by crackpots and extremists. And, remember, although normal people are horrified by Trump, the hard core, Hate Talk Radio-brain-washed Republican base still loves Trump and believes his nonsensical rantings. Mark Amodei (R-NV), for example, is a standard mainstream conservative Republican. He opposes TrumpCare and he's already being challenged by the most odious right-wing fanatic in Nevada politics, neo-Nazi lunatic Sharron Angle. (Yep... it's back!)If the Tuesday Group members feel they won't be able to win a general election if they get defeated in a primary by a radical, they might go along with Ryan and Trump. But that would make them extremely vulnerable in the 2018 midterms. Most of the members of the Tuesday Group won't even admit they're part of the group and most of them have refused to tell the press if they're voting for TrumpCare or against it, hoping it will never be voted on. That hope looks unrealistic and everyone is going to have to vote for it against it or abstain. Yesterday Alice Ollstein explained what about TrumpCare they're so scared of

• The 16-odd moderate Republicans openly opposing the latest iteration of the GOP health care bill, and the dozens who remain undecided, repeatedly cited the bill’s potential impact on patients with pre-existing conditions... After years of railing against the Affordable Care Act, even conservative GOP leaders have said that the law’s protections for pre-existing conditions are popular and should be preserved.• The GOP’s original repeal bill would have caused 24 million people to lose their health insurance, according to the non-partisan Congressional Budget Office (CBO)-- an even more devastating coverage loss than simply repealing Obamacare. Much of this rollback would come from the bill’s long-term gutting of Medicaid, including the freeze in 2020 of states that have expanded Medicaid over the last several years, and a subsequent $800 billion reduction in funding for the program.• The amendment to the bill unveiled earlier this week would also allow states to seek waivers to Obamacare’s rule that insurers cover 10 essential health benefits-- such as prescription drugs, emergency room visits, maternity care, and mental health services. In short, insurance companies will be able to charge people far more money for far skimpier plans.• [There are] concerns the national implementation of the kind of high-risk insurance pools that existed before Obamacare-- pools that priced many people out of the market entirely... The AARP estimates that if such a system is created, and not properly funded, people in those high-risk pool could have to pay more than $25,000 year in premiums alone.• No one would be hit harder by the GOP’s proposed health care overhaul than older Americans, particularly those too old to work but too young to qualify for Medicare. The CBO analysis of the original bill found that the premiums for a 64-year-old would jump by 20-25 percent by 2026 compared to leaving the current law in place. The office also predicted the number of uninsured would disproportionately rise among older people with lower incomes if the bill passed.

Yesterday afternoon a normally complacent Republican backbencher from Missouri, Bill Long-- who voted for TrumpCare in the Energy and Commerce Committee-- dealt Ryan and his team a harsh blow, announcing that he can't vote for the bill the way it was changed to please the Freedom Caucus. "I have always stated that one of the few good things about ObamaCare is that people with pre-existing conditions would be covered. The MacArthur amendment strips away any guarantee that pre-existing conditions would be covered and affordable." Exactly what Ryan doesn't want to hear and exactly what will send Trump into orbit! In fact-- no doubt giving Ryan (and Mark Meadows) heart palpitations-- Señor Trumpanzee said yesterday that "I want it to be good for sick people. It's not in its final form right now. It will be every bit as good on pre-existing conditions as Obamacare." (Yeah... and Brian Fitzpatrick of Pennsylvania, Daniel Webster of Florida and Chris Smith of New Jersey also just announced they're voting NO.) [UPDATE: Señor Trumpanzee called Long and tried "negotiating" but after the call Long said he was still a NO.]

One House Republican who has been afraid to show his hand is John Culberson, who represents a Harris County district in Texas that Hillary won and that Democrats are targeting. Culberson has never had a serious opponent before. Worse yet-- for him-- is that his likeliest opponent is renowned cancer doctor and researcher, Jason Westin, who has been relentlessly holding Culberson's feet to the fire over his refusal to consult with his constituents about the healthcare legislation. This morning Dr. Westin told us how he sees this going at this point.

With TrumpCare 1.0, Career Congressman Culberson refused to take a public position before the vote was pulled, even though he later said that he was "absolutely" for the bill. With TrumpCare 2.0, Mr. Culberson is slightly more courageous and now is letting his staff admit, while the bill is still under consideration, that he will vote for it.Here’s the thing, the overwhelming majority of TX-07 voters at Culberson’s March Town Hall were strongly opposed to TrumpCare 1.0. Did this sway Mr. Culberson, who is now in his 9th term "representing" the voters of TX-07?No.What has prompted this lukewarm bold support from John Culberson? It can’t be the 24 million Americans, including millions of children and pregnant women, and 50,000 TX-07 voters who would lose their insurance-- that was a key feature of the original. The new bill is only better if you thought the original version was too charitable. It has to be the only two additions: the waivers of essential health benefits and community ratings, which are automatically approved if the Secretary of Health and Human Services doesn’t reject them within 60 days.Waiving essential health benefits is just as bad as it sounds, but will be sold under the guise of cheaper plans that don’t actually make Americans healthier. Waiving the community rating is the truly cruel part of this bill. It will allow insurers to charge huge increases of more than 500% to the nearly 100,000,000 Americans, including 200-300,000 in TX-07 alone, with pre-existing conditions. This is already being described by Mr. Trump as "taking care of pre-existing conditions." Isn’t this effectively discriminating against hard working, tax paying American citizens by pricing them out of insurance? Yes. How do Mr. Culberson and his fellow Trump enablers justify this? Mo Brooks said it clearly: The new bill allows Americans who "lead good lives" and who have "done things right," like not getting cancer or heart disease to pay less. This philosophy of blaming the sick for their illness, and making them pay for not leading good lives or doing things right explains why the newest TrumpCare bill has garnered greater support Mr. Culberson and other radical Republicans in Congress.
TrumpCare has gone from bad to worse-- those newly kicked off insurance will not get the care they need, and as a result mild chronic conditions will become severe, and in turn, they will become uninsurable due to waived community rating.In my clinic, I’ve seen countless patients with cancer, and have yet to see a single one who caused their cancer by leading a bad life, or by doing things wrong. Implying otherwise is wrong and shameful. These sick-blaming members of Congress like John Culberson should not feel any comfort in excluding themselves from TrumpCare-- they will be looking for private insurance for themselves soon enough in 2019.